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\title{Analysis of RBC Antibody Screening in a Hospital Population Over a Two Years Period}
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             \author[1]{Dr. Richa  Jindal}

             \author[2]{Dr. Hema  Goyal}

             \author[3]{Dr. Kuldeep  Kaur}

             \author[4]{Dr. Molly  Joseph}

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\date{\small \em Received: 14 December 2017 Accepted: 31 December 2017 Published: 15 January 2018}

\maketitle


\begin{abstract}
        


RBC antibody screening plays an essential role in the pre-transfusion testing of the blood or blood products before blood transfusion in the recipients as well as in antenatal screening to prevent Rh-incompatibility. The antibody screening tests performed in a clinical laboratory/blood bank are designed to detect the presence of these unexpected antibodies especially all antibodies in the serum. Methods routinely used for detection of these antibodies are the Coomb?s test (antihuman globulin test), both direct and indirect types. 

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{I. Material \& Methods}]{I. Material \& Methods}\par
total of 378 patients and 2050 donors were included in this study period of two years (July 2016 to June 2018) in the Department of Pathology, St. Stephens Hospital, New Delhi, India. All the hospital population (patients as well as donors) blood samples were included in the study. The antibody screening tests performed were Indirect Coomb's tests, Direct Coomb's tests and Auto control. The method of screening used was gel card technology. 
\section[{II. Statistical Analysis}]{II. Statistical Analysis}\par
Qualitative variables are expressed as frequencies / percentages and compared between groups using Chi-square / Fisher's Exact Test. Quantitative variables are written regarding mean ± sd and compared using Unpaired t-test / Mann-Whitney Test. A p-value < 0.05 is considered statistically significant. The data is tabulated in MS Excel and analysis performed using Statistical Package for Social Sciences (SPSS) version 16.0 software. 
\section[{a) Study Design}]{a) Study Design} 
\section[{Cross-sectional study b) Sample Size Determination}]{Cross-sectional study b) Sample Size Determination}\par
The formula used for sample size estimation was d 2 n=Z? 2 P(1-P) 
\section[{III. Result and Discussion}]{III. Result and Discussion}\par
Our study included 378 patients and 2050 donors. The age of patients ranged from new born to 80 years with a mean age of 28.64 years. The maximum Author ? ? ? ? ¥: DNB, Junior Resident and Department of Pathology, St. Stephen's Hospital, Delhi. e-mails: jagritiyadav91@gmail.com, richa\textunderscore jindal2003@yahoo.com, hemagoyal88@gmail.com, kuldeep\textunderscore 0787@yahoo.com, mollymaria54@yahoo.co.in number of cases were in the age group of 21-30 years (58.20 \%), followed by 31-40 years (19.84 \%) and two cases were in the age group of 71-80 years (0.53 \%). Female predominance was seen with a male to female ratio of 1:5.6. The most common causative factors in our study were the previous history of transfusion, females presented with pregnancy either primigravida or multigravida and Rh-negative blood group. Blood group B was the most frequent blood group followed by blood group O. The present study has an alloimmunization rate of 3.44\% which is comparable to all the other studies mentioned above. A study by Nikam et al. \hyperref[b6]{7} had least alloimmunization rate of 0.74 \%. Choudhary et al. had the highest alloimmunization rate of 9.8\%. \hyperref[b2]{3} The percentage of alloimmunization in all the abovementioned studies fall somewhere between <1\% to 10\%. According to published data rates of alloimmunization in random patients vary from 0 to 3 observational studies in random patients, who most often receive an incidental transfusion, and pregnant women estimated the prevalence between <1-3\%. \hyperref[b11]{12} This incidence increases in multi-transfused patients and transfusion-dependent patients. The reported prevalence of alloimmunization in multi-transfused patients in India is comparatively low varying from approximately 3\% to 10\%. \hyperref[b2]{3,}\hyperref[b8]{9,}\hyperref[b12]{13}   
\section[{a) Analysis of Autocontrol in Patients}]{a) Analysis of Autocontrol in Patients}\par
Out of 378 cases, two patients showed auto control positivity.\par
Out of 378 patients, AC was positive only in two patients, and those were females (0.53\%). Among those two patients, one was Rh-positive and the another one was Rh-negative. History of previous transfusion (1.7\%) is the most common cause of auto antibodies followed by pregnancy (0.43\%). Similarly, in our study, one patient had history of transfusion and other was a pregnant female had auto control positive rate. It was observed in our study that antibodies are more commonly found in the age group between 20-40 years.\par
There is a paucity of literature on the detection of antibodies by auto control. In our study, only ten donors had antibodies in their blood (0.49\%). Makroo RN et al. drawn similar results in his study in which out of 82153 donors 227(0.27\%) had antibodies in their blood. \hyperref[b16]{17} The study by Pahuja S et al. had a total of 7756 donors out of which 4(0.05\%) donors had antibodies in their blood. \hyperref[b15]{16} Garg N et al. had a similar result of 0.09\% antibodies in 47450 donors. \hyperref[b17]{18} The blood with antibodies were discarded and not transfused to patients. 
\section[{IV. Conclusion}]{IV. Conclusion}\par
Clinically significant antibodies were frequently detected in our patients and donors population. Alloimmunization in Rh D positive women was low as compared to Rh D negative women. The previous history of transfusion was an important cause for the development of antibodies. Males were more than females in donor population showed that males are more active in donating the blood.\par
We recommended that ? Antibody screening must be done both in patients and donors to find the irregular antibodies. ? Antibody screening should be done in pregnant females to prevent Rh incompatibility or HDFN. ? Antibody screening should be done in donors to detect the presence of alloantibodies and is an important to provide compatible blood products and to avoid transfusion reactions. ? Multi-transfused patients have a high probability of developing alloantibodies, so extended screening is recommended in the patients to prevent hemolytic transfusion reactions.\begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.435063752276867\textwidth}P{0.05573770491803279\textwidth}P{0.22759562841530057\textwidth}P{0.13160291438979962\textwidth}}
\tabcellsep \tabcellsep \tabcellsep Year 2018\\
\tabcellsep \tabcellsep \tabcellsep 3\\
\multicolumn{2}{l}{Total Patients n = 378 Gender Distribution Gender n Male 57 Female 321 Total 378 Age Group (Years) Age (Years) n}\tabcellsep \% 15.08\% 84.92\% 100\% \%\tabcellsep Volume XVIII Issue II Version I\\
? 10 11 -20\tabcellsep 29 16\tabcellsep 7.67\% 4.23\%\tabcellsep ( D D D D )\\
21 -30 31 -40 41 -50 51 -60 61 -70 71 -80 Total\tabcellsep 220 75 14 13 9 2 378\tabcellsep 58.20\% 19.84\% 3.70\% 3.44\% 2.38\% 0.53\% 100\%\tabcellsep Medical Research\\
\multicolumn{2}{l}{Mean ± sd ABO Blood Group 28.64 Blood Group n A 88 B 138 AB 42}\tabcellsep ±12.13 \% 23.28\% 36.51\% 11.11\%\tabcellsep Global Journal of\\
O\tabcellsep 110\tabcellsep 29.10\%\tabcellsep \\
Total\tabcellsep 378\tabcellsep 100\%\tabcellsep \\
\multicolumn{2}{l}{Rh D Distribution}\tabcellsep \tabcellsep \\
Rh D Positive\tabcellsep 352\tabcellsep 93.12\%\tabcellsep \\
Rh D Negative\tabcellsep 26\tabcellsep 6.88\%\tabcellsep \end{longtable} \par
  {\small\itshape [Note: In our study ICT was positive in patients with mean age of 30.24 years, whereas DCT was positive in patients with mean age of 37.04 years and AC was positive with a mean age of 30.59 years.A]} 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.36428571428571427\textwidth}P{0.10225563909774435\textwidth}P{0.100125313283208\textwidth}P{0.1299498746867168\textwidth}P{0.15338345864661654\textwidth}}
Author\tabcellsep Year\tabcellsep Total Patients\tabcellsep All Immunised Patients (ICT Positive Cases)\tabcellsep The Rate of Alloimmunization (\%)\\
Sirchia et al. 1\tabcellsep 1985\tabcellsep 1432\tabcellsep 74\tabcellsep 5.2\\
Chow et al. 2\tabcellsep 1994\tabcellsep 436\tabcellsep 26\tabcellsep 6\\
Choudhary et al. 3\tabcellsep 1999\tabcellsep 81\tabcellsep 8\tabcellsep 9.8\\
Ansari et al. 4\tabcellsep 2007\tabcellsep 80\tabcellsep 3\tabcellsep 3.75\\
Roopam et al. 5\tabcellsep 2009\tabcellsep 96\tabcellsep 5\tabcellsep 5.21\\
Pahuja et al. 6\tabcellsep 2010\tabcellsep 211\tabcellsep 8\tabcellsep 3.79\\
Nikam et al. 7\tabcellsep 2011\tabcellsep 74\tabcellsep 1\tabcellsep 0.74\\
Usman et al. 8\tabcellsep 2011\tabcellsep 800\tabcellsep 30\tabcellsep 3.75\\
Sood et al. 9\tabcellsep 2013\tabcellsep 306\tabcellsep 13\tabcellsep 4.24\\
Makroo RN et al. 10\tabcellsep 2014\tabcellsep 49,077\tabcellsep 403\tabcellsep 0.82\\
Present study\tabcellsep 2018\tabcellsep 378\tabcellsep 13\tabcellsep 3.44\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.6049701789264413\textwidth}P{0.033797216699801194\textwidth}P{0.045626242544731604\textwidth}P{0.08449304174950298\textwidth}P{0.08111332007952286\textwidth}}
Author\tabcellsep Year\tabcellsep Total Patients\tabcellsep All Immunised Patients (DCT Positive Cases)\tabcellsep The Rate of Alloimmunization (\%)\\
Nakamura Y et al. 14\tabcellsep 1984\tabcellsep 421\tabcellsep 14\tabcellsep 3.3\\
Pahuja S et al. 6\tabcellsep 2010\tabcellsep 211\tabcellsep -\tabcellsep 0.47\\
Valsami S et al. 15\tabcellsep 2015\tabcellsep 2695\tabcellsep 70\tabcellsep 2.59\\
Present study\tabcellsep 2018\tabcellsep 378\tabcellsep 15\tabcellsep 4.23\\
\multicolumn{3}{l}{DCT is the cornerstone of the diagnosis of}\tabcellsep \tabcellsep \\
\multicolumn{3}{l}{hemolytic disease of the newborn (HDN). In our study,}\tabcellsep \tabcellsep \\
\multicolumn{3}{l}{out of 378 patients, DCT was positive in 16 patients. The}\tabcellsep \tabcellsep \\
\multicolumn{3}{l}{positivity rate of DCT in our study was 4.23\%. Pahuja S}\tabcellsep \tabcellsep \\
\multicolumn{3}{l}{et al. drawn similar results by DCT and had a 0.47\% rate}\tabcellsep \tabcellsep \\
of immunization. 6\tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.2833333333333333\textwidth}P{0.07981220657276995\textwidth}P{0.11971830985915494\textwidth}P{0.17159624413145538\textwidth}P{0.19553990610328637\textwidth}}
Study\tabcellsep Year\tabcellsep Total Doners\tabcellsep All Immunised Doners (ICT Positive)\tabcellsep The Rate of Alloimmunization (\%)\\
Pahuja S et al. 16\tabcellsep 2013\tabcellsep 7756\tabcellsep 4\tabcellsep 0.05\\
Garg N et al. 18\tabcellsep 2014\tabcellsep 47450\tabcellsep 46\tabcellsep 0.09\\
Makroo RN et al. 17\tabcellsep 2018\tabcellsep 82153\tabcellsep 227\tabcellsep 0.27\\
Present study\tabcellsep 2018\tabcellsep 2050\tabcellsep 10\tabcellsep 0.49\end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 			\footnote{Analysis of RBC Antibody Screening in a Hospital Population Over a Two Years Period} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{document}
